Skip to main content

Full text of "Silver sutures in surgery : the anniversary discourse before the New York Academy of Medicine, delivered in the new building of the Historical Society on November 18, 1857"

See other formats






3> -^ £> 


f > ^> 

> *> » 

* » 





"> * 

-* - 







■ *> : i» ^> 

^> ^> !> 

> i 


* * > 
' ' fife 

^_ -* - 3 > 

> > 


:>> . 

: 2^* 



* -> > 

> > • 

> > > 

»■> , 


) » > 

> v > ~ 




v> > , - 

> > 

>> > > * 


> J^T^ s 


J ^> J>^ 

^ ■ 



L> > ^> > 

> ^ 

'■■■ ->> > . 




> > > 

* > 

2>> ; 

y>j> )>. ^ -> 


Surgeon General's Office 




v- v 

<& QaaaaoQo * 



%** j*j 


ct^^ ti Vj fo 












(published by order of the academy.) 






















Printer and Stereotyper. 

8T7 & 379 Broadway N. Y. 



A special meeting of the Academy was held at the 
new building of the Historical Society, corner of Second 
Avenue and Eleventh Street, on the 18th of November, 
1857 — Dr. Mott, President, in the chair. 

The reading of the minutes of the previous meeting 
was dispensed with, when Dr. J. Marion Sims delivered 
the Anniversary Oration, being a paper on Silver Su- 
tures in Surgery. 

At its conclusion, on motion of Dr. John W. Francis, 
seconded by Dr. Beadle, the thanks of the Academy 
were presented to the Orator. 

Dr. Smith then offered the following resolution : 

Resolved, That a committee of three be appointed to wait upon 
Dr. Sims, and request a copy for publication. 

Whereupon Drs. John W. Francis, Joseph M. Smith, 
and John Watson were appointed said Committee. 

C. F. Heywood, M.D., 

Recording Secretary. 

In consequence of the length of this Discourse, parts 
of it were omitted at the Anniversary Meeting. Most 
of the illustrations accompanying it are from original 
drawings, by Dr. Thomas Addis Emmet, the accomplished 
Assistant Surgeon to the Woman's Hospital. 

J. M. S. 



Mr. President, and Fellows of the Academy of Medicine. 

On this happy return of another Anniversary, 
it must be a source of congratulation with every 
well-wisher of this Academy, to see here on the 
platform with our distinguished President, (Dr. 
Mott,) so many of the eminent men, who, like 
him, have at various times ably filled the same high 

The presence of our honored ex-presidents, 
John W. Francis, Alexander H. Stevens, Thomas 
Cock, Isaac Wood, Joseph Mather Smith, and Wil- 
lard Parker, lends additional grace, dignity, and in- 
terest to the occasion, well worthy of permanent 
historic remembrance. Long may they live to re- 
joice at the prosperity of this Academy, and to shed 
the lustre of their great names upon its labors. 


This presidential galaxy, too, is naturally 
suggestive of the names of those who have filled 
the less important post of Orator. Ten years ago 
that venerable Nestor of the profession, the devoted 
and eloquent Francis, inaugurated your anniversa- 
ries by a characteristic oration, replete with learning, 
anecdote, and historic incident, before an unprece- 
dented audience of more than four thousand spell- 
bound hearers, while thousands left unable to gain 
admittance. This mighty effort of the great and 
good man gave the community a just estimate of 
the value and importance of this learned body, 
which, it is to be hoped, we shall ever maintain. 
He was followed by the late lamented Manly. 
Then came the truthful and lucid Post ; and next, 
the learned and critical Joseph M. Smith. After 
him, the elegant and accomplished F. Campbell 
Stewart ; then the eminent, exact, and public spir- 
ited Griscom ; and last, though not least, your 
own classic Watson. 

Is it then a matter of surprise that I have mani- 
fested so much diffidence in following the footsteps 
of these distinguished men ? Apologies on such 
occasions, are too frequently affected, but were I 
to proceed without some explanation, I should do 
injustice to you, and great violence to my own sense 
of propriety. When a member of this Academy 
but little more than one year, you conferred upon 


me this distinguished honor; electing me in my 
absence, and without my knowledge or consent, — 
a compliment that I appreciate with all my heart ; 
but a consciousness of my unfitness for the place 
prompted me at once to resign ; when such men as 
Mott, Francis, Stevens, Smith, Green, Griscom, 
White, and others opposed my withdrawal, agree- 
ing, (unofficially,) that my subject should be purely 
a professional one. 

Silver Sutures in Surgery, is a subject that 
necessarily involves frequent and constant reference 
to my oWn labors, and their results ; indeed, it has 
been the theme of my life for the last twelve years. 
In selecting it I am not ignorant of the delicacy of 
my position, and of my liability to be misinterpreted, 
and to be criticised by some who do not know me 
as you do. Nevertheless I shall speak as an Amer- 
ican, plainly, frankly and fearlessly, feeling that you 
and the great mass of the profession will understand, 
and fully sustain me. So far as it concerns my ex- 
perience, personal narrative, claims as a discoverer, 
or defence against aggression, I have a right to de- 
clare them openly u from the house-tops; " and for 
this in the abstract I hold myself responsible. But, 
whether the subject matter will be considered quite 
appropriate for the occasion, is a question only for 
the fastidiously censorious ; and I shall dismiss that 
very summarily, by shifting its responsibility to the 




broad shoulders of the gentlemen just named, at 
whose solicitation I stand here to-night. 

You, who are familiar with the experience of 
that noble charity, the Woman's Hospital, will not 
be surprised, when I declare it as my honest and 
heart-felt conviction, that the use of silver as a su- 

For my country I claim the honor of this imper- 
ishable discovery, and seize this auspicious occasion 
to place permanently upon record a history of its 
origin and progress. 

Many of you already know that it was not the 
result of mere accident, but of long, laborious and 
persevering effort, based upon the immutable princi- 
ples of science, and forming one of the most beau- 
tiful examples of inductive philosophy. 

Wishing to impress upon the profession its 
importance and value in general surgery, as well as 
in injuries from protracted parturition, I shall ne- 
cessarily be compelled to draw largely and some- 
what minutely upon my past experience. But this 
will be readily tolerated by a liberal profession ; for, 
while I labor to establish principles, it will be legit- 
imate to refer to dates, and times, and places, and 
persons, and circumstances, all of which are necessary 
to place for ever beyond cavil my claims and agency 
in this discovery. 


In 1845 I conceived the idea of curing vesico- 
vaginal fistula, and entered upon the broad field 
of experiment with all the ardor and enthusiasm 
of a devotee. After nearly four years of fruitless 
labor, silver wire was fortunately substituted for silk 
as a suture, and lo ! a new era dawns upon surgery. 

This was on the 21st of June, 1849, since which 
time I have used no other suture in any depart- 
ment of surgery. 

The American Journal of Medical Sciences for 
January, 1852, contains my article on "The Treat- 
ment of Vesico-vaginal Fistula," with full and speci- 
fic directions for every stage of the operation. The 
silver suture, as then used, I called the "clamp 
suture," on account of its method of action in forc- 
ing, or " clamping " firmly together the surfaces to be 
united. Merely for its historical value, and to show 
the progress of improvement, it is here introduced. 

Fig. 1, represents the anterior wall of the vagina, 
the posterior being cut up and laid open, thus 
exposing the fistula closed by the clamp suture. 

By perforated shot compressed upon the silver 
wires, they are secured to leaden cross-bars or 
u clamps," which burrow in the vaginal tissue; the 
whole remaining till union by the first intention be- 
comes firm, when, by clipping off the shots the 
sutures are removed. 

In my own hands this method of using 



Fig. 1. 

the silver wire in 
vesicovaginal fistu- 
la was uniformly suc- 
cessful, because I al- 
ways took good care 
to make a broad and 
free scarification of 
the edges of the fis- 
tula, and to pass the 
sutures so far from 
them that the cross- 
bars or clamps would 
burrow in the vagi- 
nal tissue, there to remain till the case was permanent- 
ly cured. But my followers were not so successful, 
simply because these two important points were not 
fully appreciated. They complained that the sutures 
would cut out ; a thing that never happened with me 
in but three or four cases, and they were amongst 
my first experiments, before learning thoroughly 
the art of applying them. 

The city of Montgomery, Alabama, was the the- 
atre of my early operations. Bad health compelled 
me to leave there in 1853. I then gave Dr. 
Bozeman of that place a partnership in business, and 
indoctrinated him in my peculiar method of operat- 
ing for vesico-vaginal fistula, instructing him in my 
various modes of using silver wire as a suture, not 


only in this class of affections, but in general sur- 
gery. Not understanding its principle of action, 
and therefore failing in its practical application, he 
was quite disheartened with his ill success, when by 
mere accident he fell upon a plan of fastening the 
wire, and so modifying my method, that in awkward 
or inexperienced hands it 
became easier of applica- 
tion. Instead of passing 
the wires through the 
leaden bars on each side 
of the fistula, he passed Fi °- 2 - 

them through a concave disk or u button" which 
rests upon the surface of the parts to be united, as 
shown by fig. 2. 

Notwithstanding the fact that the doctor lived in 
Montgomery for years, without any professional posi- 
tion till I gave it to him, that he is indebted to 
me for what he could never have obtained without 
my aid, he appropriates to himself every step of 
the operation that resulted from my own indivi- 
dual and unaided efforts, — even my silver wire and 
perforated shot, the only things of any real value 
whatever, and publishes it as his operation by a 
u new mode of suture," making strenuous efforts to 
place my labors entirely in the background. 

I do not complain of modifications, but I do 


complain of a disingenuousness that would be dishon- 
orable even under widely different circumstances. 

While I know that posterity will do me full jus- 
tice, I do not even fear the verdict of my contempo- 
raries, when the whole of the facts and their 
philosophy are laid plainly before a just and discrimi- 
nating profession. But, Sir, if you wish to offer a pre- 
mium for the encouragement of secret remedies, rob 
me of my well earned claims, as the discoverer and 
propagator of a great principle that shall live as 
long as surgery is cultivated as a science, or practised 
as an art; — and, if you are particularly desirous 
to drive your young men ambitious of honorable 
distinction, from their high resolves to elevate and 
ennoble our calling, show them that you are ever 
ready to thus endorse any attempt to detract from 
the meed of their self-sacrificing efforts. 

An honorable sensitiveness on the score of pro- 
fessional claims and personal rights is natural, and 
comes home to every man, whether his reputation 
be already established, or merely prospective. — And 
no one, Mr. President, is more capable of fully 
appreciating this than your honored self, whose 
brilliant surgical achievements have so often been the 
object of envy and detraction. 

But to the facts and their analysis : — Dr. B.'s 
paper "on vesico-vaginal fistula, by a new mode of 
suture," was published in the first No. of the Louis- 



ville Review, for May, 1856. He there labors to show 
that nothing comparatively had been done for this 
injury till the use of his button, while with it, there 
could be no such thing as a failure. Although I 
knew very well why he failed with the clamp, still I 
was determined to see what advantage the button 
possessed over it, if any. 

Having at the Woman's Hospital an ample field 
for experimental observation, I lost no time in test- 
ing his modification of my suture ; and as my ex- 
periments were valuable in establishing a principle, 
I shall give a brief detail of them. 

Case T. — The 
fistula was trans- 
line, about an inch 
above the neck of 
the bladder, with 
abundant tissue, 
and every thing 
favorable for an 
easy and success- 
ful operation. The 
wires were passed 
as usual with me, 
brought through 
the u button," and fastened with the perforated 

Fig. 8. 


shot. They were removed on the ninth day, leaving 
two small fistulous openings in the line of union, 
thus showing a failure of the " button/' greatly to 
my surprise, for I could not imagine a better case for 

success. Fig. 4, a &, the 
line of cicatrized union, 
c c?, the two little fistu- 
las left in its track. 

Fig. 4. 

Case II. — Aged 57. A sister to the above, with a 
similar fistula, but a little nearer to the neck of the 
bladder. Sexual organs normally atrophied, as 
usual with women at her time of life. Operation 
on the same day, and in the same manner as Case I, 
and with a like unfortunate result; for when the 
sutures were removed on the ninth day, there was 
a small fistulous opening at the extreme end of the 
new cicatrix on the right side. 

Case III. — Aged 37. A fistula extended 
from the meatus urinarius through the urethra 
and neck of the bladder, laying the septum open, 
to within f of an inch of the cervix uteri. I 
had closed the whole of this fistulous track by a 
previous operation, except a small point in the has 
fond of the bladder, which had been purposely- 
left open for a catheter during the time the su- 
tures were applied to the injured part below; 



and now it only remained to close up this small 
fistula thus so favorably situated. The wires, (two,) 
were passed transversely and secured by the button. 

Fig. 5. 

Fig. 5 shows the little fistula a, above described. 
The operation was similar to the two preceding, and 
had a like unfavorable result ; an opening half the size 
of the former was left. Thus three very favorable 
cases for the clamp, had failed by the "button' of 
Dr. B. 

Before this result was known I had applied 
it in four other cases, three of them unfavorable, 
and where I had not succeeded with the silver 
suture after my usual method by the " clamp.' 1 

Case IV. is one in which I had united the 
anterior and posterior walls of the vagina about an 



inch above the urethra, leaving a small fistula not 
larger than the point of a common probe. 

Fig. 6, shows the cervix uteri and the vesico- 
vaginal septum destroyed by the sloughing process. 
To convert the upper part of the vagina and the 

Fig. 6. 

bladder into one common receptacle, the posterior 
wall of the vagina, at c, had been united by the wire 
and clamps to the anterior at a, leaving a small 
opening not larger than a No. 7, sewing needle. To 
this the button was applied, and failed. 

Case V. was similar, with a greater loss of sub- 
stance. There was but a small part of the neck of 
the bladder attached to the urethra. 

The mouth of the vagina had been closed by 
uniting its posterior wall to the urethra just as they 
lay naturally in contact, leaving two little fistulse 
not larger than a common-sized probe, one at each 
extremity of the line of union. I had failed to 


close these by the silver wires, secured by the 
clamps or leaden bars, and now applied them with 
the button. The operation in both instances failed. 

Case VI.-A small fis- 
tula a, fig. 7, at the neck J ^ -^ || 

of the bladder; tissue II 
scanty and indurated ; w W 

button failed, [a, &, line ^8^7 ^— ~~^mf ? 

of union effected by a ^BJy ^ 

distinguished surgeon Fig - 7 - 

before her admission to the Woman's Hospital.] 

Case VII. — Here the injury was at the neck of 
the bladder, (see fig. 9,) ; — The button was used, 
and union took place. 

Six successive failures * out of seven operations 
with the silver suture, secured by Dr. B.'s method, 
was a most astonishing result ; and it was but natu- 
ral to inquire into the cause. I had supposed that 
his success was due to the button, which was not 
the case, as the sequel will show. 

Anxious to test fairly the advantages of this 
plan of securing the silver wires, I had performed 
these seven operations in as many days, and the last 
one was executed before the result in any preceding 
case was known. 

* Subsequently cured by the silver wire, as a simple interrupted suture. 

Since the above was written, Dr. B. has published cases in which his 

button failed repeatedly in his own hands. 




In the first six operations the wires were passed 
precisely as I do when they are to be fastened by 
leaden bars and perforated shot, and they all fail- 
ed; thus establishing the fact, that the principle 
in their application essential to success with the 



Fig. 8. 

clamps, was the one to produce a failure by the 
button ; and vice versa, the principle of success by 
the button was that of failure by the clamp. 

Let me explain — 

If the clamps or leaden bars are to be used to 
secure the wires, the sutures must be passed as 
shown at 6, fig. 8, so far from the edges of the 
fistula as to allow the bars to sink down into the 


vaginal structure, making it utterly impossible for 
them to cut out. But if the disk or button is to be 
used, then the sutures are to be passed very near, 
it matters not how near, the edge of the fistula, as 
at a. 

Now if the clamps are used with the sutures 
passed as at a, they will invariably cut out, because 
there is not space enough for them to burrow ; 
whereas, if the button is used with the wires passed 
as at b, the effort necessary to draw the parts up 
into its concavity will inevitably roll over, and force 
together the undenuded surfaces between the edges 
of the scarification and the entrance of the wires, 
which will to some extent invert the fistulous edges 
proper, while the traction by the button will cause 
the sutures to cut through, as at c and d, fig. 4. 

Thus it is clearly seen why my followers failed 
with the clamp, and why I failed so signally with 
the button. 

Fig. 9, is intended to show the relations of the 
fistula in the seventh case, which was the only suc- 
cessful one of the series. It was just at the neck of 
the bladder, the tissue was deficient, and the edges 
inverted, or turned towards the pubic arch. Here 
the sutures were passed close to the edges of the 
fistula, as shown in the figure ; but when the but- 
ton was to be applied, I found that it had to be 
convex instead of concave, as so particularly recom- 



mended by Dr. B. Notwithstanding this, union 
took place. If the button had been made with a 

Fig. 9. 

concavity, and thus applied, forcing the edges of 
the fistula up into it whether or not, the wires 
would have cut out before union could have been 

These cases demonstrated very clearly to my 
own mind that Dr. B. had mistaken the philosophy 
of the suture. He attributed its success in his 
hands to the button or disk, whereas this is wholly 
an unnecessary addendum. The truth is, that the 
great success of these operations is due entirely to 


the silver wire. I had long ago demonstrated, over 
and over again, that the clamps or leaden bars and 
perforated shot were totally worthless, if used with 
silk as a suture ; in other words, that the silver wire 
was the essential part, the sine qua non of success ; 
and I had now seen that the button, to which so 
much importance was attached, had failed in six 
successive cases, while it succeeded in the seventh 
when it no longer possessed the peculiar character- 
istic thought to be essential to success. Seeing 
thus that the much vaunted button was obnoxious 
in some cases, and nugatory in others, I now began a 
series of experiments with the wire as an interrupted 
suture, without u clamps" or " buttons" so called. 

Past experience had shown me, that as an inter- 
rupted suture, it was alone sufficient in general sur- 
gery : and there was no good reason why it should 
not prove equally as effective in the injuries result- 
ing from tedious labor. It was accordingly applied 
in the following case on the 24th of June, 1856. 

Ellen, aged 30, had been the subject of repeated 
operations in various hospitals, when at last she fell 
into the hands of Dr. B. Fordyce Barker, the able 
Professor of Obstetrics in the New York Medical 
College, who sent her to the Woman's Hospital. 

The fistula was very large, extending from the 
cervix uteri down to the neck of the bladder, and 



involving the loss of nearly half of the vesical septum. 
A large mass of inflamed and hypertrophied mucous 

Fig. 10. 

membrane from the cavity of the bladder protruded 
through it into the vagina, often becoming strangu- 
lated, and producing the most intense suffering. 

Fig. 10 shows its relations. After proper scari- 
fication, seven interrupted silver sutures were pass- 
ed transversely and fastened, each separately, by a 
perforated shot. On the 8th day they were re- 
moved. The cure was perfect. 


This case with all its difficulties satisfied me that 
the silver wire was all sufficient here, as I had 
long known it to be in other departments of surge- 
ry ; and I applied it with the same unvarying suc- 
cess in other cases, dispensing with all unnecessary 
addenda, even the perforated shot ; simply tying or 
twisting the wire. 

The wire must be made of virgin silver, an- 
nealed, and small enough for a suture.* In some 
cases the needle may be armed with it, and so used ; 
but in the majority of operations about the vagina, 
I prefer to pass silk ligatures first, and with these to 
draw the wires after. The sutures should be passed 
in, near the edge of the fistula, as at fig. 9, page 20, 
taking care to embrace the whole denuded surface, 
but not to penetrate the mucous lining of the blad- 
der. They should, as a general rule, be about T 3 T of 
an inch apart, and each tied separately, by twisting 
the two ends of the wire together, then cutting 
them off, and leaving the twisted ends at least half 
an inch long, to facilitate their removal. (See figs. 
11, and 12.) 

Fig. 11, shows the method of twisting the wire. 
Two sutures are represented as secured and cut off, 
with the twisted ends bent flatly down on the sur- 

* Mr. Berenbroick, No. 83 Duane street, makes two sizes for me, No. 28 
and 29, the last being the finest and most used. 



Fig. 11. 

face, while the third is undergoing the process of 


The fulcrum of support is held firmly in the left 
hand, while a pair of forceps in the right makes 



steady traction on the wire doubled on itself, when 
by a rotary movement of the forceps the wire is 
quickly and evenly twisted, thus looping firmly 
together the edges already nicely co-apted. 

Fig. 12. 


It is unnecessary to allow the wires to remain 
longer than the 8th day. To remove them, take hold 
of the twisted end with a long delicate pair of for- 
ceps, fig. 12, pull it gently out, till the loop which was 
buried in the tissue becomes visible ; slip the blade 
of a sharp-pointed pair of scissors within it, 
and clip the wire. Then it is easily re- 
moved, straightening out and assuming the 
form of fig. 13. Some care is needed to cut 
the wire in the loop instead of the twist. 
Fig . 13 . It may not be amiss here to say, that 

beside this simplification of the suture, my position 
at the Woman's Hospital has afforded me facilities for 
making other improvements in this operation since 
my first publication in 1852 ; for instance, the spec- 
ulum, fig. 14, is altered to give a greater leverage : the 
handle curves back at about an angle of 30° instead 
of being at right angles with the blade, having a 
counter curve in the middle, while another blade 
of a different size mounts the other extremity. 
This arrangement gives the assistant great power in 
drawing the perineum back towards the os coccygis. 
I formerly used a needle with a long shaft, but 
a visit to New York some three or four months 
after the publication of my paper, (January, 1852,) 
enabled me to have some short needles and a 
needle-holder made by Tieman, which among other 
things have been appropriated by the writer in 



the Louisville Medical Review before alluded to; 
but I now prefer a simple pair of forceps with 


Fig. 14. 

serrated jaws, properly adapted to the needle as 

seen in fig. 15. 

The catheter is also improved so as to project 



Fig. 15. 

beyond the vulva, and drop the urine in a cup, thus 
protecting the person and bedding. 

Another improvement is in allowing a more 



liberal diet than formerly, but still constipating by 
anodynes and the recumbent posture. 

Fig. 16. 

But the most useful of all these improvements 
is in the position of the patient during the opera- 
tion. A few require to be placed on the knees with 
the head and thorax depressed, as I formerly did, 
and as my followers do still ; but in the great 
majority of cases, the patient may lie on the left 
side, while the operation will be executed with equal 
facility to the surgeon, and, of course, with more 
ease to the patient. 



In this position the thighs are to be flexed at 
about right angles with the pelvis, the right a little 
more than the left. The left arm is thrown behind, 
and the chest rotated forwards, bringing the ster- 

Fig. IT. 

num quite closely in contact with the table, while 


the spine is fully extended, with the head resting 
on the parietal bone. 

The patient being thus rolled over as much as 
possible on the front, the assistant standing at her 
back, elevates with the left hand the right side of 
the nates, while the right holds the speculum which 
draws up the perineum, allowing the pressure of 
the atmosphere to dilate the vagina so as to bring 
every part of it into view. This position permits 
the use of anaesthetics if desired, but I never resort 
to them in these operations, because they are not 
painful enough to justify the trouble, and risk attend- 
ing their administration. 

Having thus digressed for a few moments to 
speak of these improvements, for which we are 
indebted to that prolific field of observation, the 
Woman's Hospital, I recur again to the proper 

Previously to the experiments already detailed, 
I had used silver sutures with the leaden bars 
or clamps in all operations about the vagina, and 
perineum, and had every reason to be perfectly 
satisfied with the results ; but seeing now that 
the simple interrupted silver suture was sufficient 
in the most difficult cases of vesico-vaginal fistula, 
I lost no time in extending its use to lacerations 
of the perineum, and found it here quite as effec- 


tual ; hence I adopted it in all such cases, not 
because it is more efficacious, but because it is sim- 
pler in its application, and quite as certain in its 
results. And in no instance of lacerated perineum, 
it matters not how extensive, have I ever resorted 
to a division of the sphincter ani, which, (with the 
silver suture,) is a horrible and wholly unnecessary 

It is strange that the Profession have been so 
slow in adopting this suture. From the day its 
wonderful effects were witnessed in vesico-vaginal 
fistula in 1849, I have never used any other suture 
in any department of surgery. 

Wishing to impress upon the Profession its great 
value in general surgery, and at the same time, to 
render permanently historic my claims to priority, 
I propose to show what it has already done, as 
contrasted with the usual methods. Hence some 
little detail of facts, and dates. 

In plastic surgery it is the great desideratum. 
In May, 1850, a gentleman had the misfortune to 
lose a good part of the left ala nasi. In the opera- 
tion eight interrupted silver sutures were used — they 
were removed on the 7th day : union was perfect, 
and he soon went home with some slight tumefaction 
of the parts, which gradually subsided. 



In the course of a fortnight he returned, saying 
that in wiping the perspiration from his face, he 
discovered some pricking substance at the seat of 
the operation, which he supposed to be a bit of 
wire. He was right ; the wire was there, but easier 
felt than seen. It was removed, and found to be 
half an inch long : it had remained there four weeks, 
producing no sense of soreness, and no inflammation 
or suppuration as a silk ligature would have done, 
thus establishing the great and important principle 
that silver was as innocuous as lead, and, like it, 
might become sacculated, producing no irritant or 
poisonous effect whatever. 

I have used this simple suture with unvarying 
success in other plastic operations, a detail of which 
is here unnecessary. 

In 1852 a little boy 
some 8 years old re- 
ceived a blow on the 
upper lip, near the left 
commissure, cutting it 
through for f of an inch. 
Three interrupted silver 

sutures were applied, and n£ other dressing. I saw 
no more of him till the ninth day : union was per- 
fect, the wires remaining precisely as I had placed 
them. Their removal was like that of a delicate ear- 
ring from the ear long used to wearing it. 

Fig. 18. 



In 1853 a gentleman called on me with a very- 
bad cancroid warty excrescence, involving a large 
part of the lower lip, which had resisted all reme- 
dial efforts. Its removal was advised. He said he 
could not possibly spare the time necessary for a 
cure ; I told him that twenty minutes would suffice 
for the operation and dressing, and that he could 
then go home, (some 80 or 100 miles,) and return 
in a week. He consented. The usual operation 


Fig. 19. 

by a V incision was performed, and the cut surfaces 
united by four interrupted silver sutures, sustained 
by a single strip of isinglass plaster, with no other 
dressing. At the appointed time he returned with 
the parts perfectly united throughout, the wires 
producing no inflammatory effect whatever. 

Would any surgeon have been justifiable in send- 
ing such a case as this away for so long a time with 


the old-fashioned method by silk ligatures or the 
twisted suture ? Certainly not. And yet I felt no 
anxiety about the result, so great was my confidence 
in the safety and security of the silver wire, as then 
demonstrated by daily experience. 

In Hare-lip the results of this suture are beau- 
tiful. They should not be further apart than T 3 T of 
an inch, or even less ; thus affording good support 
and perfect co-aptation. It is necessary for them 
to remain till union is firm enough to prevent any 
widening of the cicatrice by muscular traction, 
which requires usually from five to eight days. 
As it is important to prevent any mark from 
their unequal pressure, a thin plate of some trans- 
parent material may be placed, like a delicate splint, 
on the co-apted edges, over which the wires may 
be tied, thus protecting the tender cuticle of the 
child's lip from their cutting pressure ; while at the 
same time it allows an inspection of the united 
parts, which, if necessary, can be more accurately 
fitted by gently insinuating a small probe under the 
translucent medium : a thin bit of glass in the ab- 
sence of any thing else answers the purpose admi- 
rably well. 

For this purpose I have had prepared some little 
plates of ivory, made transparent by dissolving 
its earthy constituents. This prepared ivory is 


thin, light, and capable of being cut or moulded 
into any form, but it is objectionable, as it softens 
at the temperature of the body. 

However, nature has given us a better material 
for this purpose, one to be found everywhere and 
at any time. A clarified goose-quill split into sec- 
tions, softened in boiling water, and then flattened 
out by heavy pressure, fulfils every indication in this 
" hare-lip suture." So far as absolute success in the 
operation is concerned, nothing can be added to the 
silver wire to make it more certain, and these trans 
lucent media are recommended merely for the pur 
pose of preventing scars that may result from the 
pressure of the wire. 

In Wounds of the Scalp, I have often applied 
silver sutures, and here they possess a peculiar fit- 
ness. They do away with the necessity for sticking 
plasters, and there is no need of a razor. Besides, 
of all regions of the human body this is most liable 
to traumatic erysipelas, hence the importance of 
dispensing with silk as a suture. 

Dr. Emmet, the accomplished Assistant Surgeon 
to the Woman's Hospital, removed in December, 
1856, an encysted tumor from the scalp of a lady 
aged 62. It had existed some forty years, giving 
her no inconvenience until a few months before, 
when it increased rapidly in size and became tender 


on pressure. Six silver sutures and a water dress- 
ing were applied. On the eighth day they were 
examined for the first time. Found union by the 
first intention — the wires had produced no irritation 
whatever, and from appearances they might have 
remained there without it for an indefinite pe- 
riod, although she was below the average state of 

Having applied this simple suture with the same 
unvarying success in all the minor operations, which 
it is here needless to detail, would it not have been 
strange had I failed to try it in the bloody or heroic 
ones ? Indulge me a moment to enumerate a few 
of them. 

In 1849, 1852, and 1853, I removed the 
Mamma, applying this suture, the number in each 
case varying from eight to seventeen. The wires 
were allowed to remain from seven to fifteen days. 
It is almost needless to say that in every case the re- 
sult was the same as in the smaller operations, — 
complete cohesive union. 

In 1852, (February,) I removed the principal 
part of the lower jaw bone for osteo-sarcoma, in a 
negro woman some 50 years old. It was divided 
at the angles, thus necessitating an incision of about 
ten inches after Mott's plan. The wound was 


united by eighteen silver sutures, and a simple sus- 
taining bandage applied. The whole length of it 
healed by the first intention, except an isolated 
point at the middle of the chin, through which the 
retaining ligature of the frsenum linguae had been 
passed for security. The wires were not removed 
for ten days. Had silk been used as a suture there 
would have been an absolute necessity for their 
removal in three days at the farthest, and even then 
it is almost certain that the bed of each suture 
would have been a suppurating sore. 

In 1849, 1850, and 1852, I used silver sutures 
in Amputations of the thigh and leg, and in every 
case produced union by the first intention through- 
out the whole extent of the wounds with the 
exception of the point left for the passage of the 

In all amputations, surgeons knowing the bad 
effects of ordinary silken sutures, have been in the 
habit of applying as few as possible, and trusting 
to adhesive plasters and bandages to retain the 
edges of the flaps in contact. The poisonous prop- 
erties of silk render its early removal imperative ; 
hence the wound must be disturbed before adhesion 
is firm, and thus mischief results from the surgeon's 
necessary interference. But when the silver wires 
are applied, there is no necessity whatever, under 


ordinary circumstances, for any interference till the 
parts are firmly united. 

They must be placed near enough together to 
bring closely and accurately into contact every por- 
tion of the edges of the flaps, which may now be 
sustained by a few long narrow strips of Liston's 
Isinglass plaster. It takes a little longer, and it is 
therefore a little more trouble, to apply nicely twelve 
or fifteen silver wire sutures, than to stick in clum- 
sily four or five great silk ligatures ; but when the 
stump is dressed there is no more trouble with it, 
and the wires may not be removed for eight or ten 
days, or even longer. Moreover, there is not so 
much excuse for compresses, bandages, Maltese 
crosses, and all the bungling contrivances often 
resorted to after amputations, while there is every 
facility for applying a light water dressing, which is 
the only thing usually needed in such cases. ■ 

In 1855, at the request of Dr. Willard Parker, 
the distinguished Professor of Surgery in the Col- 
lege of Physicians and Surgeons, I applied silver 
sutures to a large abdominal section in the case of a 
young lady, the subject of Ovariotomy. They were 
passed deeply through the parietes of the abdomen, 
but not perforating the peritoneal coat. Union by 
the first intention was complete — the sutures re- 
maining a week. 

Other surgeons, members of this Academy, have 


been using this suture, amongst whom may be men- 
tioned Mott, Post, Parker, Buck, Watson, Sayre, Van 
Buren, James R. Wood, Markoe, Henry Weeks 
Brown, and many others. Professors Mott, Post and 
Parker, have each for the last four years taken 
great pains to instruct their several classes in the 
use of this American discovery. 

But amongst the earliest to appreciate its impor- 
tance in connection with medical education stands 
pre-eminent, Dr. Gilman, the learned Professor ot 
Obstetrics, etc., in the College of Physicians and 

Sufficient detail in the way of facts and dates 
has now been given to place beyond controversy my 
claims, not only to priority in the discovery and 
promulgation of a great principle, but in its univer- 
sal application in general surgery. 

But all the special departments of surgery have 
not been indicated in which this simple and won- 
derfully beautiful suture may be successfully used. 
As soon as I became aware of its value, I was very 
anxious to apply it in Wounds of the Intestines, and 
particularly after the occurrence already alluded to, 
where a wire remained four weeks in the nose with- 
out producing the slightest disturbance; but no 
opportunity presented till April, 1853. 

A young negro man was stabbed in the left side 


between the sixth and seventh ribs ; and in the ab- 
domen there were two cuts, through which pro- 
truded large masses of wounded intestines. These 
intestinal wounds (some of them transverse, and 
others diagonal) were closed with simple interrupted 
silver sutures, which were cut off close to the intes- 
tine, and the whole returned to the abdominal cavity. 
He lived twenty -four hours. 

The post-mortem examination, made by Dr. B. C. 
Jones of Montgomery, Alabama-, and Dr. Cum- 
mings, now of New Orleans, showed that the 
thoracic wound had passed downwards through the 
diaphragm into the stomach. The perforation in 
the diaphragm was completely plugged by omen- 
tum, but not till the contents of the stomach had 
passed through it into the pleural cavity. 

Fig. 20. 

There was no effusion or evidence of active in- 
flammation in the peritoneal cavity; the silver 
wires had neatly closed the wounds in the bowel, 


(duodenum cut, ileum and jejunum transfixed in 
three places,) and for an inch around them there 
was a delicate little effusion of plastic lymph nicely 
gluing the wounded parts to the adjacent perito- 
neal coat, while every thing else was in a perfectly 
normal state. 

Fortunately he lived long enough to indicate 
pretty clearly the propriety of using silver sutures 
in wounds of the intestines. I expected them to 
become sacculated like lead, and to remain there 
innocuously, to be taken care of in nature's own way. 

I have long felt satisfied that the great danger 
from Wounds of the Peritoneum was due not so 
much to the mere admission of atmospheric air as 
to the universal use of ligatures and sutures, left like 
setons to irritate and inflame this delicate serous 
membrane. Operations for Hernia are of frequent 
occurrence, and if performed before strangulation 
results in sphacelus, are amongst the safest of all 
grave operations. They show very plainly that the 
peritoneum may be opened and handled with com- 
parative immunity.* For the truth of this assertion 

* Dr. Warren Stone, the distinguished Prof, of Surgery in the Medical 
Department of the University of Louisiana, who, as a great practical teacher, 
ranks with the most eminent in this country, or any other, says of hernia, 

u That no disease is so dangerous to life, and yet so entirely remediable" 

that u the bowel is in danger from the moment it is strangulated, and should 
be relieved as soon as possible " — that u the hernial sac can be exposed without 
the slightest risk"— and that u if it should be necessary to open the hernial 
sac, it can be done with as much safety as venesection can be performed at the 
bend of the arm." [New Orleans Medical Journal) Jan, 1858, page 79.] 


I appeal here to Mott and Stevens, to Watson and 
James R. Wood, and to every other surgeon in this 
Hall. Why then such dread of peritoneal wounds ? 
Why such fear of peritonitis in Ovariotomy ? 

But is there any wonder that Ovariotomy is so 
fatal, when a great silken cord strangulates the 
pedicle and hangs from the abdomen, its whole 
track a suppurating sinus ? And, when six, or eight, 
or ten silken sutures close the external wound, each 
one answering most admirably the purpose of a 
seton ? 

Simpson, the great European luminary of Obstet- 
ric Surgery, plainly saw the source of danger, and 
says, "If betimes it come to be recognized as a surgi- 
cal operation fit and proper in such cases of ova. 
rian disease as he adverted to, he had no doubt the 
steps of the operation itself would meet ivith improve- 
ments" and that "probably it might be possible to 
devise some other measures of securing the large 
vessels, principally veins be it remarked, of the ped- 
icle, and thus save the several dangers arising from 
the ligature."* 

Europe, through this great man, thus calls for 
improved measures of safety, which America now 
proudly lays at her feet. For silver sutures and 
silver ligatures are to do more to rob this dread 
operation of its dangers than all else that has yet 

* Obstetrical Works, 1st Series, page 256. 


been suggested. Let the pedicle of the tumor be 
firmly tied with a silver, or leaden wire — let the ex- 
ternal wound be united by silver sutures — let the 
vaginal cul de sac be punctured, (as has already been 
done by our distinguished Fellow, Prof. Peaslee,)* 
for a canula to drain off, through the most depend- 
ent point of the peritoneal cavity, any exudation, 


whether of blood, serum, or pus, and a degree of 
security will be given to this operation that may 
yet rank it with hernia under its most favorable cir- 

But enough has been said to fix attention upon 
the importance of this suture, and its universal ap- 
plicability in general surgery. 

It is to revolutionize surgical dressings, and to 
ensure more beautiful and prompt cures. With it, 
properly applied, there can be no gaping wounds 
to heal by the suppurating process, where there 
is skin enough to cover a stump ; and in many cases 
erysipelatous inflammation, and even hospital gan- 
grene, may be averted by substituting it for silk as 
a suture. 

After all amputations we must use sutures of 
some sort ; and how often do we see silk ulcerating 
out, and creating such tendency to suppuration, 
that we are compelled to remove them before there 
is sufficient uniop to resist the retraction of the tu- 

* American Journal of Medical Science, Jan. 1857. 


mefied flaps. But with silver there is no inflamma- 
tion, no suppuration, no cutting out of sutures, no 
gaping or retraction of flaps, and therefore no neces- 
sity for disturbing the dressing till all is firmly 
united and permanently well. 

This is no vain imagining : though enthusiastic, 
I am not wildly so, for all this has been familiar to 
me for the last eight years, and I but speak what I 
know. The next eight years will not find an edu- 
cated physician anywhere who will dare to use silk 
sutures, for the silver thread will now become as es- 
sential to the dressing case as the needle itself; and 
if I may be allowed to venture a prediction, I will 
say that fifty years hence the statistics of our hospitals 
will show a vast improvement in their bills of mor- 
tality after great operations, and this improvement 
will be due mainly to the use of silver as a suture. 

Look at its results in injuries of the vagina. 
Before this discovery, operations for vesico-vaginal 
fistula, and its congeneric affections, were often at- 
tended with risk to life, while a cure was a mere 
accident. But how is it now ? Why, every case is 
easily and perfectly curable that has tissue enough 
to render any operation whatever practicable ; while 
a failure is the exception to the rule. Besides, 
there is not the least risk to life, as there is 
never any fever, or the slightest constitutional dis 


I am not claiming too much for this suture when 
I say, that the same relative results must be attain- 
ed in all other surgical operations requiring sutures, 
if the same method be adopted. 

My language is in nowise extravagant; and I 
shall yet live to see the day, when the whole pro- 
fession of the civilized world will accord to this sim- 
ple discovery the high position of being the most 
important contribution as yet made to the surgery 
of the present century. 

The only thing at all comparable to it is Ether- 
ization ; and in practical results of permanent bene- 
fit it is absolutely contemptible, when compared 
with those from the universal use of silver sutures 
in the broad domain of general surgery. 

Having now briefly shown that I have used sil- 
ver sutures with uniform success in almost every 
imaginable injury requiring sutures, these practical 
remarks might very properly be here closed ; but, 
as concentrated efforts have been made in various 
quarters to rob me of full credit for my labors, I 
have thought it due to truth, to justice, to poster- 
ity, and to myself, to place permanently upon rec- 
ord a history of the circumstances attending this 

Some of my contemporaries will not approve 
the measure, but when this generation passes there 


will be no difference of opinion amongst critics on 
this point; besides, it will not be unprofitable 
should it stimulate but one young aspirant for fame 
and fortune to redoubled efforts, under unpromising 
circumstances and opposing obstacles, to the accom- 
plishment of still more glorious triumphs for our 
noble profession. 

Although fully fortified by the necessity of self- 
vindication, still I hesitate and tremble ; but why 
should I be afraid to write, and speak, and publish 
to the world, what I am not ashamed to acknowledge 
to any individual, viz. — that it was all the result of 
a Providential train of circumstances over which I 
had no control, and that it pleased God to lead me 
in this direction in spite of my predilections. 

As the field of my labors thus partakes somewhat 
of a missionary character, a labor of love under 
Divine guidance for the furtherance of a truly be- 
nevolent purpose, you will pardon a personal nar- 
rative, which under other circumstances would be 

For the first ten years of my professional life 
the treatment of any disease peculiar to woman was 
ignored as far as possible. Surgery was my ambi- 
tion, and it was gratified, for my head, and heart, 
and hands were full. This was due, not to any par- 
ticular merit on my part, but, to a fortunate position 
amongst a liberal and enlightened profession in the 


noble state of Alabama, a profession, which, for in- 
telligence and a chivalric esprit de corps, is not 
behind that of any other state in this great confed- 

Thus situated, a case of vesico-vaginal fistula 
was sent to me in July, 1845, which was investi- 
gated more because I had a surgical reputation to 
sustain than from any particular interest in the sub- 
ject. It was, of course, dismissed as incurable. 
Two months after this another presented, which re- 
ceived a like verdict. Two cases in such quick suc- 
cession in a country town, at that time, formed an era 
in one's life; imagine my surprise, when, • a few 
weeks after this, a gentleman called to consult me 
about a third case. I told him promptly that it was 
useless to send her to me, as the injury was wholly 
incurable. He suggested that there was a possi- 
bility of my being mistaken in my ready diagnosis ; 
when I replied, that a leakage of urine following a 
protracted labor was an infallible sign of a vesical 
fistula. But my remonstrances were unavailing, for 
he sent her to town in spite of me. 

I investigated the case thoroughly, reading 
every author I could find on the subject, but to no 
purpose, for all was darkness and confusion ; and 
thus I was on the eve of sending her home, when a 
little incident occurred that formed the turning point 
of my professional career, and without which the 


discovery that has engaged our attention to-night 
would not have been made. 

A lady was riding in the suburbs of the city of 
Montgomery, Alabama, and her pony taking fright, 
jumped suddenly, when she fell to the ground, 
striking on the sacrum. I saw her soon afterwards; 
her sufferings were extreme, as she had rectal and 
vesical tenesmus from a sudden retroversion of the 
uterus. To replace the dislocated organ was the 
indication of relief. Following the teachings of 
learned professors, the patient (covered with a 
sheet) was placed on the knees with the pelvis ele- 
vated, and the thorax depressed, when by manipu- 
lation through the vagina and rectum, I hoped to 
replace it. Introducing the right forefinger into 
the vagina, but remembering how a nervous gen- 
tleman had suffered a few days before from a rectal 
examination, I concluded not to subject this lady to 
the same disagreeable operation, particularly as it 
seemed possible to overcome the difficulty if my 
finger was only a little longer. My middle finger 
is more than half an inch longer than the index, but 
it could not be used without its fellow ; and thus 
the two were passed, and in a few seconds I could 
not touch the uterus, or even the walls of the vagina, 
and the fingers were swept around as it were " in 
empty nothingness," which was to me at the moment 


a most puzzling mystery, and while I was endeavor- 
ing to unravel it, my patient exclaims, " Oh doctor, 
I am relieved !" My office was ended, for my mission 
was to relieve her, but how it was done I could not 
understand. While I stood doubting and wonder- 
ing, my patient, now easy, threw herself down on 
her side, producing thereby a sudden escapement 
of air from the vagina ; and thus the whole mystery 
of the accidental reduction of the dislocated uterus 
was explained on the principle of atmospheric pres- 

And what was its rationale ? When the patient 
was in the position described, there being a natural 
tendency of the pelvic viscera to gravitate towards 
the epigastric region, it would require no great vis 
a tergo to produce the desired result in a recent case 
of this kind. One finger, however, was not long 
enough to throw the organ up, nor were the two ; 
but when they were both introduced, in my vary- 
ing manipulations and strenuous efforts, the hand 
was accidentally turned with its palm downwards, 
which thus brought the broad dorsal surface of the 
two parallel fingers in contact with the vulvar com- 
missure, thereby elevating the perineum and ex- 
panding the sphincter muscle, which allowed the 
air to rush into the vagina under the palmar surface 
of the fingers, where, by its mechanical pressure of 
fifteen pounds to the square inch, this canal was 


dilated like a balloon, and the uterus replaced by 
its pressure alone. This accident — there are no 
accidents in the providence of God ! — this inci- 
dent, then, occurred just at the right time. Had it 
happened six months sooner, its importance would not 
have been duly appreciated. Had it been six days 
later, the golden opportunity for its practical appli- 
cation would have been lost forever ; for my mind 
had been sorely perplexed by the obscurity sur- 
rounding the investigation of the cases before 
alluded to, and I said to myself, u If by this position 
the atmospheric air can be made to dilate the vagina 
to such an extent, even with a force strong enough 
to reduce a dislocated uterus, why will not the same 
principle allow me to explore this region, and exam- 
ine accurately any injury, or disease to which it may 
be liable ?" Full of the thought I hurried home — and 
the patient, (with vesico-vaginal fistula,) who was to 
have left on the next day, was placed in the position 
described, with an assistant on each side to elevate 
and retract the nates. I cannot, nor is it needful to 
describe my emotions, when the air rushed in and 
dilated the vagina to its greatest capacity, whereby 
its whole surface was seen at one view, for the first 
time by any mortal man.. With this sudden flash 
of light, with the fistulous opening seen in its proper 
relations, seemingly without any appreciable process 
of ratiocination, all the principles of the operation 


were presented to my mind as clearly as at this time. 
And thus in a moment, in the twinkling of an eye, 
new hopes and new aspirations filled my soul, for a 
flood of dazzling light had suddenly burst upon my 
enraptured vision, and I saw in the distance the 
great and glorious triumph that awaited determined 
and persevering effort. From this moment my high 
resolve was taken ; nor did I think, or care for the 
personal sacrifices I should have to make. I thought 
only of relieving the loveliest of all God's creation 
of one of the most loathsome maladies that can 
possibly befall poor human nature; and in this, I 
honestly confess that I was stimulated by feelings of 
national pride, as well as by a desire to advance our 
glorious profession. Full of sympathy and enthusi- 
asm, thus all at once I found myself running headlong 
after the very class of sufferers that I had all my pro- 
fessional life most studiously avoided. Ransacking 
the country around, my medical brethren soon dis- 
covered and placed at my disposal, some seven or 
eight cases of vesico-vaginal fistula that had been 
quietly laid up as incurable. Building a little hos- 
pital as a special field of experiment, I readily 
got control of these cases, all of them healthy young 
negro women ; promising to perform no operation 
that would endanger life, or render their condition 
any worse. Having no proper instruments, and no 
instrument maker, dentists, jewellers and black- 


smiths were laid under contribution, and soon such 
rude instruments were made as were suggested by 
the peculiar wants of individual cases. This occu- 
pied a period from the 9th of December, 1845, to 
the 10th of January, 1846, when the first operation 
was performed. 

Several medical friends, amongst whom were 
Drs. Boling, Holt, Ames, Baldwin, Jones, McWhor- 
ter and Henry 7 were invited to the inauguration of 
the experimental series. When the mechanical 
contrivances were exhibited, the peculiarities of 
each case pointed out, and the principles of the 
operation explained, they thought my plan of pro- 
cedure promised well, while some were but little 
less enthusiastic than myself in hopes for the future. 

The first was a very simple case, and one that 
any tyro in surgery could now cure in a week's 
time. The fistula was an 
inch and a quarter long, 
transverse, in the base of 
the bladder, with an abun- Flg - 21 * 

dance of tissue. Its edges were accurately adjusted, 
and I expected to effect at once a magical cure ; 
but greatly to my surprise and mortification it was 
a failure. However, the size of the opening was 
reduced from that seen in the diagram to one not 
larger than a No. 4 bougie: this encouraged me 
considerably, and the same operation was tried on 


another case with a like unfortunate result, and after 
this, with various, and constantly varied modifica- 
tions on others, till each one had suffered numerous 
operations, but all to no purpose. And thus I 
worked on, not for weeks and months, but for long 
weary years, before a single case was cured. My 
repeated failures brought a degree of anguish that 
I cannot now depict, even were it desirable. All 
my spare time was given to the development of a 
single idea, the seemingly visionary one of curing 
this sad affliction, which not unfrequently follows 
the fulfilment of the law pronounced by an offend- 
ed God when he said to the woman, u In sorrow 
and suffering shalt thou bring forth children." 

Soon my friends began to despair of my efforts, 
and one by one became tired of such profitless work. 
At last Dr. B. R. Jones, my partner, an accomplished 
physician, who had stood firmly by, giving his valua- 
ble advice and assistance, importuned me to cease 
my efforts; thus opposed at home, and deserted by the 
professional brethren who once cheered me on by 
their personal presence, I now stood alone — alone ! 
did I say ? no, I was not alone, for I felt that I had a 
mission, if not of a Divine character, at least but 
little short of it, of Divine origin. I felt that the 
God who had called me to this good work, and in- 
spired me with new views for its accomplishment, 
was with me, and would not desert me. I could 

woman's moral courage. 55 

not have ceased my labors if I had tried, for some- 
thing told me that the fulness of time had arrived, 
that the work had to be done, and that if I should 
fall, God in his wisdom would raise up some one as 
an instrument to carry it forward to a glorious con- 
summation. I was not alone then ; — nor was I alone 
in another sense, for I had succeeded in infusing my 
own courage and enthusiasm into the hearts of the 
half dozen sufferers who looked to me for help, and 
implored me to repeat operations so tedious, and at 
that time often so painful, that none but a woman 
could have borne them. 

To the indomitable courage of these long-suffer- 
ing women, more than to any one other single cir- 
cumstance, is the world indebted for the results of 
these persevering efforts. Had they faltered, then 
would woman have continued to suffer from the 
dreadful injuries produced by protracted parturi- 
tion, and then should the broad domain of surgery 
not have known one of the most useful improve- 
ments that shall forever hereafter grace its annals. 

In my first experiments the quilled suture was 
used, securing the ligatures by passing them through 
little canulae that projected from the vulva. 

Fig. 22, shows the rude contrivance, which 
was made of silver. The canulse were firmly 
soldered to the proximal quill, and when the liga- 
tures were tightened and wrapped round the end 



that projected from the vagina, the fistulous edges 

were neatly co-apted by 
the quills. This is intro- 
duced merely to show the 
slow degrees by which 
practical truths are some- 
times developed. After 
using this machine various- 
ly modified for nearly three 
years, giving attention 
mostly to the perfection 
of the self-retaining cathe- 
ter, I at last concluded that 
the projecting canulae were 
a chief cause of failure, 
and consequently deter- 
mined to dispense with 
them: but how to secure 
the ligatures was the ques- 
tion. A detail of the num- 
berless expedients resorted to is useless ; suffice it to 
say, that I was at last driven completely to the wall. 
I had resolved never to repeat another operation 
till I had devised some plan of fastening the quill 
suture without the canulae — of tying a knot where 
I could not reach it with the fingers. Thus my brain 
was sorely puzzled ; I had not performed an opera- 
tion for nearly six weeks, and my devoted patients 


were begging me from day to day, to " try only one 
more time." Notwithstanding their importunities, I 
had determined first to invent a knot for my sutures ; 
but it seemed that my usual readiness of expedient 
had now deserted me. My brain was oppressed ; my 
heart was heavy ; but never for one moment did I 
despair of eventual success. At last I happened to 
remember that, when a boy, I used to make sinkers 
to my fishing lines by cutting a shot half in two, lay- 
ing the line in the cut, and then compressing the 
shot on it with my teeth. I cannot express the de- 
light that filled my heart at this simple suggestion. 
The idea occurred to me on the night of the 14th 
November, 1 848. The contemplation of its beauty, 
simplicity, and perfect adaptation to the purpose, 
gave me a sleepless night ; for there I lay with 
etherealized brain, performing in imagination a 
magical cure on each of my devoted patients. This 
was, as I thought, the consummation of all my plans. 
After a struggle for three years, victory was about 
to crown my efforts. How I longed for the morn- 
ing, that I might put to the test of experiment what 
seemed so beautiful in theory. But I was doomed 
to wait another twenty-four hours before proving 
my principle ; for just as I was preparing for the 
operation, a call to the country appropriated the day, 
and thus the longest day of my life was lengthened 
out by hope deferred. But bright and early on the 


succeeding morning, I applied the quill suture se- 
cured by the perforated shot. It was all I could 
desire — I was never so well satisfied with any ope- 
ration in all my life. How anxiously I waited for 
its results. I had at last gotten rid of the canulae 
that had so long been such a serious obstacle to 
success, and every thing was propitious ; but these 
bright hopes were of short duration, for I soon had 
unmistakable evidence that the operation was a 
total failure. What was the cause of it? why, said 
I, it must be because the silver quills are too large ; 
so I began to lessen their size till they were not 
more than a line in diameter, and on account of the 
expense of silver, lead was substituted : but notwith- 
standing these modifications, there was no more suc- 
cess than at the beginning. What now was to be 
done ? The principles of the operation were clear, 
and its mechanism seemed to be perfect. At first I 
had supposed my failures were due to the imperfec- 
tion of the catheter ; that was perfected, and then 
I laid the blame on the method of securing the su- 
tures by means of the canulae ; they were replaced 
by the perforated shot, and then I looked to the 
size of the quills, and reduced them, so that they 
burrowed nicely in the tissues: it then seemed that 
success was inevitable, but still disappointment 
awaited me at every turn. 

Thus far all my experiments were conducted on 


the principles of a rational inductive philosophy. 
The operation was mechanically perfect, but with 
no better results than when it was rude and clumsy. 
There must be a reason for all this — what was it ? 
Why, said I, perhaps it is in the nature of the mate- 
rial more than in its principle of action ; what a 
happy thought ! — Of course it was, for a silk thread 
introduced under the skin, and allowed to remain a 
week, becomes a seton, giving rise to the suppura- 
tive process, and certainly the same thing must oc- 
occur with it in the vagina ; and how then could 
there be cohesive union ? Here then was the diffi- 
culty at last ; how strange it now seemed to me that 
this fact had not long ago forced itself upon my 
mind. Now the question arose, was there a substi- 
tute for silk that would answer the same purpose, 
and yet not poison the animal tissue ? Why, lead 
remains indefinitely in the body, becomes sacculated, 
and produces no poisonous, or suppurative effect. 
Dr. Levert * of Mobile, had demonstrated the innoc- 
uousness and efficiency of leaden ligatures on the 
arteries in the lower animals, and Mettauer and Dief- 
fenbach had actually used leaden sutures in these 
very cases ; and I had in my various experiments 
tried them in two cases of vesical, and one of rectal 
fistula, but fortuijately for science, the clumsy leaden 
wire was unsuccessful in my hands. Was there any 

* American Journal of Medical Sciences, No. VII., May, 1829. 


other metal that could be substituted for lead, pos- 
sessing its valuable property of harmlessness ? 

In this train of inquiry what would be more 
readily suggested to the reasoning mind than silver, 
gold, and platinum?* Just at this stage of affairs I 
happened to pick up a piece of brass wire, that had 
been used in a pair of old fashioned suspenders made 
before the days of India rubber ; it was as fine as or- 
dinary sewing thread. I took it to a jeweller, who 
imitated it in silver. I was now quite as anxious to 
see the result of an experiment with this, as I was 
seven months before to see the perforated shot ap- 
plied. On the 21st June, 1849, it was done. A 
young colored woman, who had never murmured 
at the preceding failures, was placed on the ope- 
rating table for the thirtieth time, and the silver 
sutures were applied, with the leaden bars and the 
perforated shot. In all previous operations the ure- 
thra, in a day or two, would become red and ten- 
der, and the urine loaded with thick tenacious 
mucus, thus showing the inflammatory process, 
which was adverse to union ; but after this opera- 
tion, the urine remained perfectly limpid all the 
time, and on the eighth day the parts were per- 
fectly healed; the suture apparatus remaining just 

* All these I have used, but adopt the silver, because it is as good as gold, 
and cheaper. 


as it was placed, with the crossbars somewhat bur- 
rowed in the vaginal tissue. 

I shall not dwell upon my feelings at this time. At 
last I had attained what I had worked for nearly four 
years ; and it was but a few weeks before all the 
cases were cured that had been the subject of ex- 
periment for so long a time. I was anxious to get 
a few more cases to settle some doubtful points, be- 
fore publishing to the world my discovery ; but un- 
fortunately with the realization of my dreams, and 
in the full fruition of my most sanguine hopes, came 
a sad reverse. An exacting practice and the ex- 
treme mental tension of the past four years had 
produced a collapse, long foreseen by friends, with- 
out my consciousness of its approach. Having con- 
tracted the chronic disease of a warm climate, which 
is almost universally fatal, and struggled hard for 
more than two years, and as it seemed, hopelessly 
against my fate, thus seeing that death was inevitable, 
and fearing' that I might die without the world's 
reaping the benefit of my labors, I determined to 
give my experience, crude as it was, to the profes- 
sion that I loved so much. And accordingly, in Oct. 
1851, my paper u On Vesico-Vaginal Fistula" was 
dictated, and sent to Dr. Isaac Hays, of Philadelphia, 
who published it in the Am. Jour, of Med. Sciences 
for Jan. 1852, as my last free-will offering on the 
altar of science. I little thought of living to see it 


in print, but it has pleased an All-wise God to re- 
store me again to health, and by a mysterious Prov- 
idence to place me in your midst, where I have 
found nought but friends and kindness. 

Mr. President, I have thus hastily sketched a 
truthful, unexaggerated statement of the train of cir- 
cumstances, which led to results that must ever be 
remembered as an achievement of American Sur- 
gery. But, Sir, I feel that an apology is due this 
Academy, for a personal narrative, although neces- 
sary for the vindication of right and the establish- 
ment of truth. 


Fellow Associates : 

I have said much of Silver Sutures, showing 
what they have already done, and pointing out the 
great revolution they are to effect in all surgery ; 
but my task would be unfinished were I not to lay 
before you in this connection every good work they 
have achieved, — indulge me then a moment longer. 

In justice to the Medical Profession of this 
mighty Metropolis, which is truly represented by this 
Academy, I beg leave here to state a few facts that 
must necessarily become historic; and, if historic, 
could the occasion be more propitious than now, in 
this beautiful new edifice of the New York Histori- 
cal Society, which was but last night dedicated 


by an eloquent address from the venerable and 
learned Dr. Francis. 

But for Silver Sutures, that noble Charity, the 
Woman's Hospital, would not have been called into 
existence. — Do you ask how this is so? Let me 
glance briefly at its origin. 

As before remarked, driven by a seemingly in- 
exorable fate from my Southern home and friends 
in search of health, repeated observations made 
during the summers of 1850, 1851, and 1852, 
showed that I could regain it in this great city — 
and nowhere else — for whether I crossed over to 
Brooklyn, sailed up the Sound to the "land of 
steady habits," roamed over the Highlands of the 
noble Hudson, quaffed the waters of the far-famed 
Saratoga, loitered by the seaside, or scaled New 
England's lofty mountains, it was all the same with 
me — but, whenever I tarried in New York, its pure 
soft Croton water and bracing air, would invariably 
banish my dread disease. Thus the law of self- 
preservation drove me here in spite of sectional 
prejudice and an innate horror of a large city. Soon 
after my arrival, on the 15th of October, 1853, Dr. 
Mott called, and gave me the first patient I ever 
had in New York. It was a very bad case of utero- 
vesico-vaginal fistula, which had been sent to him 
from Canajoharie. 

Having read an account of Silver Sutures, he 


honored me with a request to apply them in this 
case, which, so far as the records show, was the first 
of the kind ever remedied in the State of New 
York. This brought me frequently in contact with 
Dr. Mott, who encouraged and sympathized with 
my views on the necessity of establishing a great 
hospital in this city to be devoted to the treatment 
of the diseases peculiar to woman. He sent me to 
Dr. Francis, whose broad and comprehensive views 
greatly contributed to shaping its destiny. Dr. 
Francis saw at once its bearings upon the interests 
of humanity, the advancement of science, and the 
cause of Medical Education. He was its earliest 
advocate, its unwavering friend. To his personal 
influence and overpowering eloquence is due in a 
great measure the hold it has upon the sympathies 
of the community, and the confidence of the Pro- 
fession — well may he be styled God-Father to the 
Woman's Hospital. 

Dr. Horace Green, the founder of the New York 
Medical College, was too much interested in the 
cause of medical education not to see its importance, 
and he aided it with wise counsel and earnest 

Dr. Griscom, Dr. Barker, Dr. Gardner, and Dr. 
Reese, were amongst its earliest friends. But the 
first man to suggest a proper method of co-operative 
action was Dr. Alexander H. Stevens, who, though 


little given to enthusiasm on ordinary occasions, 
seemed to be fired with this idea of a Woman's 
Hospital, and wrote a letter to Bishop Wainwright, 
(which is now in the possession of the Rev. Dr. 
Muhlenberg,) and taking a broad view of the sub- 
ject, he at once said: " You are right in thinking 
this movement should emanate from the Medical 
Profession ; a meeting must be called, and you must 
address it." But I declined, because I was unused 
to public speaking, and feared to endanger a good 
cause by a possible failure. 

However, I soon discovered that I could do 
nothing otherwise, and was forced to adopt the sug- 
gestion of Dr. Stevens, inviting the Profession to a 
lecture on the subject at the Stuyvesant Institute, 
No. 659 Broadway, on the 18th of May, 1854. 

The interest felt was manifested by a large 
attendance, representing every phase of the Profes- 
sion. After the lecture, Dr. Delafield was called to 
the chair, and Dr. Beadle requested to act as secre- 
tary, when Dr. Griscom moved " That the meeting 
coincide to the utmost extent with the views of the 
lecturer of the evening," sustaining his motion ably 
and eloquently. He was followed successively by 
Drs. Gardner, Greene, Kissam, Reese, and others, 
when the meeting unanimously adopted the hospital 
movement as its own, authorizing the chairman to 

appoint at his leisure, a committee of ten, five lay- 



men and five medical men, to organize plans for 
future action; Dr. Delafield was added by this 
meeting to the committee which it authorized him 
to appoint. 

The selection of this committee was a matter of 
grave importance, — how could it be composed so as 
to combine all interests in the Profession into one 
harmonious whole ? How else but by representing 
the cause of Medical Education? Accordingly, Dr. 
Stevens, from the College of Physicians and Sur- 
geons,— Dr. Mott, from the University Medical 
College, — Dr. Green, from the New York Medical 
College, — Dr. Francis, as the Father of Obstetric 
Medicine in New York, — with Dr. Delafield and 
your Orator, comprised the medical branch of the 
Committee — while Mr. Peter Cooper, and Mr. Eras- 
tus C. Benedict, were the only laymen ever selected. 

This endorsement by the united voice of the 
Profession was the quickening principle in this hos- 
pital movement ; without it, there could have been 
no vitality — no existence. 

The kindly sympathy of the Profession was 
shown, too, by a liberal patronage in placing at my 
command a large number of surgical cases, fit sub- 
jects for Silver Sutures, that were clamorous for aid. 
Having no place for them, and feeling the urgency 
of prompt action, then it was that the members of 
this Committee allowed me to appeal to the mothers 

woman's hospital association. 67 

of our city to aid us in this good work for their suf- 
fering sisters. 

The time has not arrived for a complete histori- 
ography of the Woman's Hospital, and it is not my 
intention here to individualize the noble band of 
heroic women, who, when we had been working for 
several months with no practical results, called a 
meeting of some thirty ladies in the quiet parlor of 
a private residence, (No. 27 St. Mark's Place,) on 
Saturday the 10th of February, 1855, when the 
" Woman's Hospital Association" was formed, 
which elected a Board of Managers with the fol- 
lowing officials, viz. : — 

Mrs. David Codwise, . . . . 1st Directress, 

" Wm. B. Astor, 2d 

" Ogden Hoffman, 3d 

" Jacob Leroy, Treasurer, 

" T. C. Doremus, Assist. Treas. 

" Dr. Horace Webster, .... Secretary. 

This Board raised funds, rented a building, No. 
83 Madison Avenue, and opened the hospital on the 
4th of May, 1855, electing the gentlemen as its 
Medical Board who had been previously appointed 
as a committee of organization. 

Nor did they stop here ; for as soon as they saw 
the need of more room, they joined the Medical 
Profession in an appeal to the Legislature for funds 




and a new Charter, merging it into a State Institu- 
tion, of which the present Board of lady Managers 
will constitute a Board of Supervisors having charge 
of its domestic management, while its Board of Gov- 
ernors, composed of New York's choicest sons, will 
organize it and manage its finances. And what are 
now its prospects for the future? With fifty-six 
thousand dollars in hand, with an implied under- 
standing in our Charter to get from the State a large 
appropriation as soon as her financial condition will 
allow it, with a sympathy for its success that per- 
vades every intelligent family in the city, and many 
throughout the State, and with the expectation of 
obtaining from the city a site valued at a hundred 
thousand dollars — does not the Woman's Hospital 
bid fair to take its place as one of the fixed institu- 
tions of the country ? And who should feel prouder 
of this than this Academy ? Although the Acad- 
emy had no opportunity, as such, of moving in the 
matter, still the leading members of this learned 
body are its prominent friends. The Medical Pro- 
fession have never before, in any country, shown 
such unity of purpose as here, in regard to this 
Woman's Hospital. Look for a moment at their 
Memorial to the Legislature last year in its behalf. 
it was signed by every Professor in the College 
of Physicians and Surgeons; by every Professor 
in the University Medical College ; by every Pro- 


fessor in the New York Medical College ; % by all 
the leading practitioners of the city to whom it was 
presented ; by every Physician to each of our five 
Dispensaries ; by the Surgeons and Physicians to all 
our other Hospitals, and when it was sent to Albany, 
it received the unanimous endorsement of the 
State Medical Society. Was ever before such union 
seen in the Medical Profession ? Pardon me if I 
should call it a u Union by the first intention/' 
effected by Silver Sutures. 



OF TriE 




President, John Stearns, M.D. 

{Francis U. Johnston, M.D. 
Thomas Cock, M.D. 
John B. Beck, M.D. 
John W. Francis, M.D. 

Recording Secretary, F. Campbell Stewart, M.D. 

Domestic Corresponding Secretary, William C. Roberts, M.D. 

Foreign Corresponding Secretary, Benjamin Drake, M.D. 

Treasurer, Robert Watts, Jr., M.D. 

Librarian, Thomas M. Markoe, M.D. 

Orator, John W. Francis, M.D. 


President, John W. Francis, M.D. 

f Thomas Cock, M.D. 
_ . , John B. Beck, M.D. 

Vice-Presidents, ^ j K Rqdgers, M.D. 

[w. W.Miner, M.D. 

Recording Secretary, F. Campbell Stewart, M.D. 

Assistant Secretary, Marcus L. Taft, M.D. 

Domestic Corresponding Secretary, William C Roberts, M.D. 

Foreign Corresponding Secretary, Gurdon Buck, Jr., M.D. 

Treasurer, James 0. Pond, M.D. 

Librarian, Thomas F. Cock, M.D. 

Orator, James R. Man ley, M.D. 



President, Valentine Mott, M.D. 

(Isaac Wood, M.D. 
James R. Manley, M.D. 
Galen Carter, M.D. 
Thomas Cock, M.D. 

Recording Secretary, John L. Vandervoort, M.D. 

Assistant Secretary, T. M. Franklin, M.D. 

Domestic Corresponding Secretary, Wm. C. Rorerts, M.D. 

Foreign Corresponding Secretary, John G. Adams, M. D. 

Treasurer, James 0. Pond, M.D. 

Librarian, Thomas F. Cock, M.D. 

Orator, Alfred C. Post, M.D. 


President, Isaac Wood, M.D. 

r Galen Carter, M.D. 
Tr . r> ., . Joseph M. Smith, M.D. 
V«*-PreszdentsA j. C . Bliss, M.D. 

A. C Post, M.D. 

Recording Secretary, John G. Adams, M.D. 

Assistant Secretary, Jackson Bolton, M.D. 

Domestic Corresponding Secretary, Wm. C. Roberts, M.D. 

Foreign Corresponding Secretary, Edward L. Beadle, M.D. 

Treasurer, James 0. Pond, M.D. 

Librarian, Thomas F. Cock, M.D. 

Orator, Joseph M. Smith, M.D. 


President, Alexander H. Stevens, M.D. 

f Galen Carter, M.D. 

T7 . n ., . ! Joseph M. Smith, M.D. 
Vice-Presidents, < T jr t> ' lfn 

' John K. Rodgers, M.D. 

John P. Batchelder, M.D. 

Recording Secretary, John G. Adams, M.D. 

Assistant Secretary, Jackson Bolton, M.D. 

Domestic Corresponding Secretary, Wm. C. Roberts, M.D. 

Foreign Corresponding Secretary, Edward L. Beadle, M.D. 

Treasurer, James 0. Pond, M.D. 

Librarian, Thomas F. Cock, M.D. 

Orator, F. Campbell Stewart, M.D. 



President, Thomas Cock, M.D. 

'Joseph M. Smith, M.D. 

T .. _ . , James Anderson, M.D. 

Vice-Presidents, A j p BatchelI)ERj m . d . 

Gurdon Buck, Jr., M.D. 

Recording Secretary, Jackson Bolton, M.D. 

Assistant Secretary, George A. Peters, M.D. 

Domestic Corresponding Secretary, Wm. C. Roberts, M.D. 

Foreign Corresponding Secretary, Edward L. Beadle, M.D. 

Treasurer, James 0. Pond, M.D. 

Librarian, Thomas F. Cock, M.D. 

Orator, F. Campbell Stewart, M.D. 


President, Isaac Wood, M.D. 

f E. L. Beadle, M.D. 
T ,. T3 ., F. C. Stewart, M.D. 

Vice-Presidents, 1 Wm DetM0 ld, M.D. 

I^Willard Parker, M.D. 

Recording Secretary, Samuel A. Purdy, M.D. 

Assistant Secretary, J. Foster Jenkins, M.D. 

Domestic Corresponding Secretary, Samuel T. Hubbard, M.D. 

Foreign Corresponding Secretary, S. Conant Foster, M.D. 

Treasurer, James 0. Pond, M.D. 

Librarian, Thomas F. Cock, M.D. 

Orator, J. A. Swett, M.D. 


President, Joseph M, Smith, M.D. 

f James Anderson, M.D. 

TT . D ., . j E. L. Beadle, M.D. 
Uce-PresidentsA Wm DetmoU)j lUD . 

[ J. H. Griscom, M.D. 

Recording Secretary, Samuel A. Purdy, M.D. 

Assistant Secretary, Edwin B. Stimson, M.D. 

Domestic Corresponding Secretary, Samuel T. Hubbai:d, M.D. 

Foreign Corresponding Secretary, S. Conant Foster, M.D. 

Treasurer, Jamks 0. Pond, M.D. 

Librarian, THOMAS V. Cock, M.D. 

Orator, John H. Griscom, M.D. 



President, John W. Francis, M.D., LL. D. 
f E. L. Beadle, M.D. 

Vice-Present^ \ F * C ' Stewart > MD - 
vice cements, ^ GuRDON BuCK> M ^ 

^Wm Detmold, M.D. 

Recording Secretary, S. Con ant Foster, M.D. 

Assistant Secretary, John W. Green, M.D. 

Domestic Corresponding Secretary, Samuel T. Hubbard, M.D. 

Foreign Corresponding Secretary, John G. Adams, M.D. 

Treasurer, James O. Pond, M.D. 

Librarian, Thomas F. Cock, M.D. 

Orator, John Watson, M.D. 


President, Willard Parker, M.D. 
f John Watson, M.D. 

Vice-Presidents, \ Jackson Bolton M.D. 
j Gurdon Buck, M.D. 
[_ Edward L. Beadle, M.D. 
Recording Secretary, S. Conant Foster, M.D. 
Assistant Secretary, W. F. Holcomb, M.D. 
Domestic Corresponding Secretary, Samuel T. Hubbard, M.D. 
Foreign Corresponding Secretary, John W. Green, M.D. 
Treasurer, James 0. Pond, M.D. 
Librarian, Thomas F. Cock, M.D. 
Orator, Wm. Detmold, M.D. 


President, Valentine Mott, M.D. 
f James R. Wood, M.D. 

Vice-Presidents A ? DWA 5? L ' Bea ?^ M.D. 
John Watson, M.D. 

B. Fordyce Barker, M.D. 
Recording Secretary, C. F. Heywood, M.D. 
Assistant Secretary, F. U. Johnston, Jr., M.D. 
Domestic Corresponding Secretary, Samuel T. Hubbard, M D. 
Foreign Corresponding Secretary, John W. Green M.D. 
Treasurer, James 0. Pond, M.D. 
Librarian, Thomas F. Cock, M.D. 
Orator, J. Marion Sims, M.D. 



President, J. P. Batchelder, M.D. 

fC. E. Isaacs, M.D. 

rr t> • 7 , W. H. Van Buren, M.D. 
\ tee-Presents, i JoHN Watson> m ^ 

S. Conant Foster, M.D. 

Recording Secretary, C. F. Heywood, M.D. 

Assistant Secretary, F. U. Johnston, M.D. 

Domestic Corresponding Secretary, Samuel T. Hubbard, M.D, 

Foreign Corresponding Secretary, John W. Green, M.D. 

Treasurer, James O. Pond, M.D. 

Librarian, Samuel Rotton, M.D. 



R. S. Kissam, M.D. J. H. Griscom, M.D. 

James Anderson, M.D. E. L. Beadle, M.D. 

Benjamin Ogden, M.D. Galen Carter, M.D. 

W. N. Blakeman, M.D. 


[Those marked with an asterisk are decease*!.] 

Thomas W. Blatchford, M.D., Troy, *Bureaud de Riofrey, M.D., Paris. 

N. Y. Samuel D. Gross, M.D., Philadelphia, 

Jean Civiales, M.D., Paris. Perm. 

♦Theodoric Romeyn Beck, M.D., Al- Philip Ricord, M.D., Paris. 

bany, N. Y. " Alfred L. M. Velpeau, M.D., Paris. 

Thomas Harris, M.D., Washington. J. C. Townsend, M.D., Long Isl., N.Y. 
Louis Agassiz, Prof. Harvard Univer- Jean Jacques Joseph Leroy d'Etiolles, 

sity. M.D., Paris. 

Sir Henry Holland, M.D., London. Prince Krom Luang Wongsa Tirat 
Martial Dupierris, M.D., Havana. Sanit, Siam. 

Ashbel Smith, M.D., Texas. Paul Dubois, M.D., Paris. 

William Fergusson, M.D., London. G. Andral, M.D., Paris. 
Samuel H. Dickson, M.D., Charleston, F. Rilliet, M.D., Paris. 

S. C. E. Barthez, M.D., Paris. 

Worthington Hooker, M.D., New Ha- J. Guggenbuhl, M.D., Paris. 

ven, Conn. Jacob Bigelow, M.D., Boston. 

E. D. Fenner, M.D., New Orleans. James Y. Simpson, M.D., Edinburgh. 
P. M. 1 toget, M.D., London. John Hughes Bennett, M.D., Edin- 

P. V. Z. Amussat, M.D., Paris. • burgh. 

Edward Revnolds, M.D., Boston, Mass. Edward K. Peaslee, M.D., N. Hamp- 
*Joel A. Wing, M.D., Albany, N. Y. shire. 




Abbott, Norman 
Acosta, Elisha 
Adams, John G. 
*Andariese, James W. 
Anderson, James 
Andrews, Jarvis M. 
Ashburn, Robert A* 
Aylett, Philip Augustus 
Ayres, Daniel, Jr. 

*Barker, Luke 
Bartles, 0. S. 
Barker, B. Fordyce 
Barry, Robert A. 
Batchelder, J. P. 
Bay, John W. 
Baylies, Bradford S. B. 
Baylies, Hersey 
Beadle, E. L. 
Beales, J. C. 
*Beals, Gorham 
*Beck, John B. 
Bedford, G. S. 
Benedict, George 
Berger, Francis E. 
Blakeman, Wm. N. 
*Bliss, James C. 
Bliven, J. P. 
Blois, Samuel 
Blumenthal, Mark 
Bogert, Cornelius R. 
Bogert, S. V. R. 
Bolton, Jackson 
Borrowe, J. H. 
Bowen, William 
♦Boyd, Thomas 
Booraem, Augustus C. 
*Brady, Patrick J. 
Brown, Henry Weeks 
Brown, William K. 
Brueninghausen, Charles 
Buck, Gurdon 
Buel, W. P. 
Bulkley, H. D. 
Bum stead, F. J. 
*Bullus, Edward 
Budd, Chas. A. 
Burke, Wm. C. 
Busteed, John 
Burrill, James 
Byrne, John 

*Cameron, James 
Cameron, John S. 
^Campbell, James 
Campbell, N. L. 
Carroll, Daniel J. 
Carter, Galen 
Carter, J. S. 
Catlin, S. H. 
Chalmers, Thomas C. 
Chapin, E. R. 
*Chapin, John R. 
Cheesman, John C. 
Childs, S. Russell 
Church, Allen S. 
Clark, Alonzo 
Clark, Patrick 
Clark, Peter F. 
Clarkson, C. V. 
Clements, J. W. G. 
Clinton, Alexander 
Cock, Thomas 
Cock, Thomas F. 
Collins, C. T. 
Conant, D. S. 
Cooke, John 
Cooper, James S. 
Corson, J. W. 
Covel, John C. 
Cox, Abm. L. 
Crane, James 
Crane, John J. 
*Creveling, Abm. 
Cullen, H. J. 

Dalton, J. C, Jr. 
Davis, E. H. 
Davis, John 
Delafield, Edward 
Detmold, William 
Douglas, J. Hancock 
Douglas, Robert 
Downs, Henry S. 
Drake, Benjamin 
Dudley, Wm. H. 
Dwight, Wm. W. 

Eadie, W. G. 
*Earle, Edward 
Earle, Pliny 
Edgar, David A. 
Edwards, Frank S. 
Eliot, Ellsworth 



Elliot, Augustus G. 
Elliot, Fredk. W. 
Elliot, Geo. T., Jr. 
Elliott, James W. 
Elliott, Thomas W. 
Elder, Alexander 
Ellis, Samuel C. 
Emmet, Thomas Addis 
Enos, Dewitt C. 

Ferguson, John G. 
*Ferris, Floyd T. 
Ferris, Lynde C. 
Fields, Edward 
Finnell, T. C. 
Fisher, George S. 
Fisk. Lyman 
Fitch, James D. 
Forrester, James C. 
Foster, Joel 
Foster, S. Conant 
Foy, Michael E. 
Francis, John W. 
Franklin, Edward C. 
Franklin, Thomas M. 

Gallagher, John 
Gardner, Augustus K. 
Garrish, John P. 
Geer, Seth 
Gescheidt, Anthony 
Gilford, Jacob T. 
Gilman, Chandler R. 
Gibert, James T. 
Goodrich, Charles S. J. 
Gliick, Isidor 
Gomez, Horatio 
Gouley, J. W. 
*Graham, John 
Gray, H. M. 
*Green, David 
Green, Horace 
*Greene, Isaac 
Green, John W. 
Gray, F. C. 
Griscom, John H. 
Guernsey, H. 
Guernsey, Peter B. 
Gunn, A. N. 

Hall, Edwards 
Hall, Samuel 
*Halsted, J. 
Halsted, Thad. M. 
Harcourt, James 

Hardenbrook, J. R. 
Harris, Elisha 
Harris, Stephen R. 
Hart, John 
Heard, John S. 
Henriques, A. J. 
Henschel, Charles 
Hepburn, James C. 
Herriot, George 
Herzog, M. 
Heywood, Charles F. 
Hills, Samuel A. 
Hintoh, J. H. 
Hirsch, Simon 
*Hobart, W. H. 
*Hogan, Daniel M. 
Hoit. Moore 
Holcomb, Wm. F. 
Horsfield, R. T. 
Horsfield, T. W. 
Hubbard, Samuel T. 
Huntington, G. F. 
*Hunter, Abraham T. 
Husted, N. C. 
Hutchison, J. C. 
*Hutchinson, E. F. 
Hyslop, George L. 

Isaacs, Charles E. 
Ives, George W. 
Ives, John 

Jackson, Wm. H. 
Jackson, Francis H. 
Jacobi, A. 
Janes, E. H. 
Jenkins, J. Foster 
*Johnston, F. U. 
Johnston, F. U., Jr. 
Jones, E. Lee 
Jones, Wm. W. 
Jones, A. S. 
Johnson, Wm. S. 

Kammerer, J. 
*Kearney, Ravaud 
Keene, Stephen S. 
Kennedy, James 
Kilbourne, J. Sage 
Kimbark, Everett H. 
♦Kingsbury, G. H. 
Kissam, Richard S. 
Krackowitzer, E. 
Kuypers, S. S. 



Ladd, John G. 
Learning, James R. 
Lee, Charles A. 
Lee, J. C. 
Lee, Thomas D. 
Leo- Wolf, George 
Leo-Wolf, Morris 
Leveridge, Benjamin C. 
Levings, N. C. 
Lewis, Geo. 
Lewis, W. C. 
Linsly, Jared 
Livingston, W. C. 
Ludlow, E. G. 
Lyon, James L. 

McCaffrey, Charles 
McClelland, John 
McCready, B. W. 
McClaury, J. 
McLeod, S. B. W. 
*Macdonald, James 
Macfarlan, Ebr. 
*MacNeven, W. H. 
Manley, James 
*Manley, James R. 
Markoe, Thomas M. 
Martin, Joseph 
*Marvin, David D. 
Maxwell, W. H. 
*Meikleham, D. S. 
Metcalfe, John T. 
Merritt, J. R. 
Miller, Francis 
Miller, John 
*Miller, W. Ellison 
Millett, Nicholas 
Miner, William 
Miner, William W. 
Minor, James M. 
Mitchell, Chauncey L. 
Monell, J. A. 
Moore, Edward 
*Moore, S. W. 
*Moran, Thomas 
Morris, R. L. 
Moses, Israel 
Mott, Valentine 
McNulty, John 
Mullen, P. A. 
Murray, Alexander 

*Neilson, John 
Nelson, James B. 

Newcomb, George 
Nichols, Elias S. 
Nichols, Henry W. 
Ogden, Benjamin 
Ogden, John D. 
Olmsted, Roger S. 
O'Reilly, John 
O'Rorke, James 
Owen, J. Leech 

Palmer, L. N. 
Parker, E. H. 
Parker, Willard 
* Parkinson, W. B. 
Paul, James C. 
Peaslee, Edmund R. 
Pennell, Richard 
Pentz, Elias J. 
Perry, Joseph S. 
Peters, George A. 
Phelps, James L. 
*Phillips, S. B. 
*Platt, Wm. F. 
Pond, James 0. 
Porter, Mortimer G. 
Post, Alfred C. 
Powers, T. W. 
Power, William 
Pratt, Peter 
Priestley, John 
Proudfoot, L. 
Punnett, John 
Purdy, Alfred S. 
Purdy, S. A. 
Purple, S. S. 
Putnam, F. A. 

Quintard, Charles T. 

Randolph, Israel 
Ranney, E. W. 
Ranney, M. H. 
Raphael, B. 
Reese, David M. 
Revere, F. B. 
Richards, T. W. 
Rising, J. C. 
Roberts, Wm. C. 

* Robeson, A. B. 
Rockwell, William 
*Rodgers, J. Kearny 

* Rogers, J. Smyth 
Ross, James 
Rotton, Samuel 



Sabine, Gustavus A. 
Sayre, Lewis A. 
Schilling, E. 
Schirmer, William 
Schmidt, J. W., Jr. 
Seaman, Richard S. 
Sewall, John G. 
Shanks, John 
* Sherwood, Burnt t 
Sims, J. Marion 
South worth, M. A. 
Smith, Charles D. 
Smith, Dfivid 
*Smith, Gilbert 
Smith, J. Lewis 
Smith, Joseph M. 
Smith, James 0. 
Smith, Stephen 
*Snowden, John 
; Spring, Edward 
Stearns, John 
Stephens, James J. 
Stephenson, Mark 
Stevens, Alexander H. 
Sterling, John W. 
*Stickney, J. Dwight 
Stewart, James 
Stillman, J. D. B. 
Stillwell, J. E. 
Stewart, F. Campbell 
Stimson, Edwin B. 
Stone, John 0. 
Storer, Ebenezer 
Stout, Arthur B. 
Strube, F. 
Sweeny, Hugh 
Sweeny, Owen 
*Swett, John A. 
Swift, H. S. 

*Taft, Marcus L. 
Taylor, Isaac E. 
Tellkampf, Theodore A. 
Thayer, Henry W. 
Thomas, T. Gaillard 
Thompson, A. G., Jr. 
Tomes, Robert 
*Townsend, Peter S. 
Trudeau, James 
Tucker, C. P. 
Tuttle, John T. 

Underhill, Alfred 

Uhl, David 

*Vache', Alexander F. 
Van Arsdale, Henry 
Van Arsdale^ Henry 
Van Arsdale, Peter 
*Van Buren, Thomas 
Van Buren, P. 
Van Buren, William H. 
Vanderpool, Edward S. 
Vandervoort, John L. 
Van Hovenburgh, H. 
Van Kleek, John R. 
Van Pelt, M. D. 
Van Rensselaer, Alex. 
Van Roth, W. 
Van Winkle, Ed. H. 
Varick, Theodore R. 
Vermilye, Wm. E. 
Voss, L. H. 

Wallace, W. W. 
Walsh, Hugh 
Warner, E B. 
Warren, James 
* Washington, James A. 
Watson, John 
Watson, Alex. T. 
Watts, Robert 
Weed, John W. 
Weeks, Cyrus 
Wells, Daniel 
Wells, Ovid P. 
Westervelt, John S. 
White, Ambrose L. 
White, Francis W. 
White, Oliver 
White, Samuel P. 
Wight, L. L. 
Wilhelm, H. N. 
Wilkes, George 
Williams, M. W 
Wilson, William 
Wood, Isaac 
Wood, James R. 
Wood, Stephen 
Woodhull, H. B. W. 
Woodward, George F. 
Worster, Joseph 
Wright, Aaron 

Young, William. 



V c r < "r 


rr c ; 


cc c 

r" *-• 


* v c 

; Cf , 

<«? j 





fc . c 

5e "«r ' 


r c 


c <cr 





r < ' 

' r '< ■ p 

c <: < 

, C c fcc«v 


, > c • «<: 

C C 




1 OCT < c << 

« CC >c < 


< * j 

^-<:< c